The Influence of Routine Health care on Reoffending in a Sample of Gun Involved Youths.

In the wake of heightened concerns about gun violence and its impacts on youth, "what works" in gun violence prevention remains a critical public health concern. Gun violence prevention in the U.S. is increasingly interdisciplinary, involving both the criminal legal system and the health care system in developing an evidence base for promising programs and policies. The current study contributes to the literature by examining recidivism outcomes (i.e., rearrest) for a cohort of n = 409 Indianapolis youth involved in gun violence who were court-ordered to complete a health education-based prevention program called Project Life. The youth in our sample were predominantly from marginalized communities, all had been charged with a gun-involved or violence offense, 96% were detained by the juvenile justice system for some time, and 64% received at least one routine well check within five years prior to Project Life. Survival analyses of merged juvenile court records and health records show that routine health care (i.e., well visits) and completing the Project Life program were protective against recidivism, whereas time spent in detention increased risk. The findings provide evidence for the value of interdisciplinary approaches that include the health system in disrupting cycles of gun violence, while reducing the carceral footprint on youth.

Effect of an elder abuse and self-neglect intervention on repeat investigations by adult protective services: RISE project.

BACKGROUND: Adult Protective Services (APS) is the primary agency responsible for investigating elder abuse and self-neglect (EASN) allegations in the United States. The harms of EASN are well established; however, APS lacks a conceptually derived evidenced-based intervention phase. RISE is a community-based intervention designed to complement APS that provides enhanced services and a longer intervention phase. The objective of this study was to test whether exposure to the RISE/APS collaboration was associated with reducing the case outcome of recurrence (repeat investigations) compared to usual care APS only services. METHODS: A retrospective observational study (n = 1947) of two counties in Maine where RISE was available to provide enhanced services to persons referred from APS. An extended regression endogenous treatment Probit model using APS administrative data was used to predict case recurrence. RESULTS: Between July 2019 and October 2021, 154 cases participated in RISE and 1793 received usual APS only services. 49% of cases in RISE had 2 or more prior substantiated allegations versus 6% for those receiving usual APS care, and 46% of cases in RISE had a recurrence during the observation period versus 6% for usual care group. However, after accounting for the non-random treatment assignment, RISE was associated with a significantly lowered likelihood of recurrence compared to persons receiving usual care provided by APS (probability of recurrence reduced by 0.55 for the Average Treatment Effect on the Treated and 0.26 for the Average Treatment Effect). CONCLUSIONS: A reduction in recurrence carries important implications for APS clients, costs, resources, and workflow. It may also serve as a proxy indicating a reduction in revictimization and harm for EASN victims.

Use of Motivational Interviewing by Advocates in the Context of an Elder Abuse Response Intervention: The RISE Project.

Purpose: Despite the increasing number of elder abuse and self-neglect (EASN) cases, many older adults are reluctant to engage with formal support services, such as Adult Protective Services (APS). This study examined the use of motivational interviewing (MI) by advocates, as a component of a larger EASN intervention, RISE (Repair Harm, Inspire Change, Support Connection, Empower Choice), implemented in partnership with APS. Advocates applied MI as part of RISE to help clients explore and resolve ambivalence around pursuing change and ultimately enhance service engagement. Methods: This study conducted qualitative interviews and a focus group with all RISE advocates (n = 4) to understand how MI is applied in the context of an EASN intervention with older adult clients. A descriptive phenomenological approach involving two independent assessors was used to code verbatim transcripts into themes. Results: Three domains were identified: (1) therapeutic relationship, which describes the importance of foundational relationship building in MI to support older adults who have experienced EASN; (2) techniques, which refers to MI strategies advocates apply and adapt in the context of EASN intervention; and (3) implementation challenges, which reflects the difficulties advocates encounter when using MI in cases of EASN. Conclusions: The experiences of advocates suggest MI is a beneficial and amenable approach to help older adults who have experienced EASN navigate issues of ambivalence and explore their motivation for change. This study represents the first in-depth exploration of MI in the context of EASN intervention.

RISE: A Conceptual Model of Integrated and Restorative Elder Abuse Intervention.

Despite a growing number of elder abuse (EA) cases nationwide, response programs such as adult protective services (APS) lack a defined, prolonged intervention phase to address these complex situations. This article presents RISE, a model of EA intervention that works alongside APS or other systems that interact with at-risk older adults. Informed by an ecological-systems perspective and adapting evidence-based modalities from other fields (including motivational interviewing, teaming, restorative justice, and goal attainment scaling), the RISE model intervenes at levels of the individual older adult victim, individual harmer, their relationship, and community to address EA risk and strengthen systems of support surrounding the victim-harmer dyad. The RISE model addresses an intervention gap in existing systems to better meet the needs of EA victims and others in their lives, leading to more sustainable outcomes.

A qualitative evaluation of the "RISE" elder abuse intervention from the perspective of adult protective services caseworkers: addressing a service system gap.

Our understanding of effective elder abuse (EA) response interventions is limited. Adult Protective Services (APS), the primary agency responsible for responding to EA, lacks a coherent, conceptually driven, prolonged intervention phase. Informed by an ecological-systems perspective and adapting evidence-based modalities from other fields, the RISE EA intervention addresses this APS systems gap. Based on a three-year pilot project involving a partnership between RISE and Maine APS, the current study conducted a qualitative evaluation of RISE, from the perspective of APS caseworkers (n = 14) who worked with RISE, to understand RISE strengths and areas for improvement. Findings suggest APS workers perceive that RISE complements the scope and nature of APS, enhances APS caseworker well-being, and reduces repeat APS cases, while further APS/RISE collaboration and clarification on RISE role responsibilities and referral eligibilities are areas of growth. This study provides preliminary evidence for RISE as a community-based EA intervention in partnership with APS.

Racial Differences in Hospital Evaluation After the Use of Force by Police: a Tale of Two Cities.

OBJECTIVE: To determine whether racial or sex bias or the number of officers influences the chances of reported injury or hospital evaluation after the use of less than lethal force by law enforcement. METHODS: Retrospective cohort study of 12,326 incidents of less than lethal force in Indianapolis, Indiana (2014-2018), and Wichita, Kansas (2008-2018). RESULTS: Injuries to non-White persons are under-reported (Indianapolis Pr ≤ 0.003; Wichita Pr ≤ 0.000) and non-White persons are less likely to be referred for hospital evaluation after the use of force (Indianapolis OR 0.57, CI 0.45-0.72, Wichita OR 0.66, CI 0.48-0.92). In Indianapolis, the presence of more than one officer significantly reduced the odds of hospitalization after both injury and serious injury (OR 0.48, CI 0.36-0.64 for injury, OR 0.22, CI 0.12-0.39 for serious injury). For both cities, an estimated 25% more non-White persons who were subject to the use of force should have been evaluated in a hospital than actually were. CONCLUSIONS: Significant racial disparities exist in the reporting of injuries and in the access to care after the use of force by law enforcement. IMPLICATIONS: Policies, procedures, and training need to be amended to correct the disparities in access to care after the use of force. Access to sequestered law enforcement data is imperative to assess the extent of these disparities nationwide.

Developing a rigorous, systematic methodology to identify and categorize elder mistreatment in criminal justice data.

Elder mistreatment is complex, with cases typically requiring integrated responses from social services, medicine, civil law, and criminal justice. Only limited research exists describing elder mistreatment prosecution and its impact. Researchers have not yet examined administrative prosecutorial data to explore mistreatment response, and no standardized analytic approach exists. We developed a rigorous, systematic methodologic approach to identify elder mistreatment cases in prosecutorial data from cases of crimes against victims aged ≥60. To do so, we operationalized elements of the accepted definition of elder mistreatment, including expectation of trust and vulnerability. We also designed an approach to categorize elder mistreatment cases, using the types of charges filed, into: financial exploitation, physical abuse, sexual abuse, verbal/emotional/psychological abuse, and neglect. This standardized methodological approach to identify and categorize elder mistreatment cases in prosecution data is an important preliminary step in analyzing this potentially untapped source of useful information about mistreatment response.

Association of comorbidity and outcome in episodes of nonspecific low back pain in occupational populations.

We examined the relationship between comorbidity and first return to work after episodes of work-disabling, nonspecific low back pain (NSLBP). An inception cohort of workers with new episodes of NSLBP was identified from administratively maintained occupational health records. We compared 6-month return-to-work rates between workers with one or more comorbid conditions with those without documented comorbidity. Workers with comorbidity were 1.31 times more likely to remain work disabled than those with uncomplicated NSLBP, after adjusting for age, gender, lifting demands, and company membership (adjusted hazards ratio [HR] = 1.31; 95% confidence interval [CI] 1.12 to 1.52). Concurrent injury (i.e., sprains or strains of the neck, upper extremity, and lower extremity; contusions; and lacerations) had the strongest association (adjusted HR = 1.49; 95% CI, 1.21 to 1.83), followed by musculoskeletal disorders (adjusted HR = 1.13; 95% CI, 0.77 to 1.66). Comorbidities should be routinely evaluated at first visit by occupational health professionals to better manage disability associated with LBP.